Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients
| Autor: | Philippe Chevalier, Arnaud Ribier, Denis Barborier, Christine Mestre Fernandes, Alain Pinel, Madeleine Vincent, Roland Itti, Serge Bonijoly, Emilie Nonin, Laurence Bontemps, Raphael Dauphin, Patrick Bert-Marcaz |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Heart Ventricles medicine.medical_treatment Cardiac resynchronization therapy Radionuclide ventriculography Kaplan-Meier Estimate Risk Assessment Sensitivity and Specificity Disease-Free Survival Ventricular Function Left Cardiac Resynchronization Therapy Predictive Value of Tests Risk Factors Internal medicine Natriuretic Peptide Brain medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies cardiovascular diseases Radionuclide Ventriculography Aged Proportional Hazards Models Heart Failure Chi-Square Distribution Receiver operating characteristic Proportional hazards model business.industry Patient Selection Hazard ratio Middle Aged medicine.disease Peptide Fragments Confidence interval Logistic Models Treatment Outcome Heart failure Predictive value of tests Linear Models cardiovascular system Cardiology Female France Cardiology and Cardiovascular Medicine business Biomarkers Follow-Up Studies |
| Zdroj: | Circulation: Cardiovascular Imaging. 4:114-121 |
| ISSN: | 1942-0080 1941-9651 |
| DOI: | 10.1161/circimaging.110.950956 |
| Popis: | Background— Phase analysis, developed to assess dyssynchrony from ECG-gated radionuclide ventriculography, has shown promising results. We hypothesized that quantifying the cardiac resynchronization reserve, that is, the extent of response to cardiac resynchronization therapy (CRT), by radionuclide imaging could potentially identify patients who are best suited for CRT. Methods and Results— Seventy-four patients ages 64.8±10.1 years were prospectively studied from July 2004 to July 2006, of whom 62.2% and 37.8%, respectively, were in New York Heart Association class 3 and 4. Mean QRS width was 173±25 ms. ECG-gated radionuclide ventriculography to quantify interventricular and intraventricular dyssynchrony was performed at baseline with and without CRT and at the 3-month follow-up visit. Amino-terminal-pro-brain natriuretic peptide (NT-pro-BNP) levels were also determined at baseline and at 3 months. During a mean follow-up of 10.1±7.6 months, there were 37 (50%) clinical events that defined the nonresponder group, including cardiac death or readmission for worsening heart failure. In multivariate Cox model analysis, higher NT-pro-BNP blood levels were associated with a significant increase in the risk for event (hazard ratio=1.085 for a 100 pg/L increase in NT-pro-BNP; 95% confidence interval, 1.014 to 1.161). Each 10° elevation in intraventricular dyssynchrony was associated with a decrease in the risk of events (hazard ratio=0.456, 95% confidence interval, 0.304 to 0.683). Receiver operating characteristic curve analysis demonstrated that an interventricular dyssynchrony cutoff value of 25.5° for intraventricular synchrony yielded 91.4% sensitivity and 84.4% specificity for predicting a good response to CRT. Conclusions— The quantification of interventricular dyssynchrony with radionuclide phase analysis suggests that early postimplantation interventricular dyssynchrony may provide identification of CRT responders. |
| Databáze: | OpenAIRE |
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